What’s preventive care?
Preventive care includes routine checkups, tests, and screenings that help identify health issues early, when they’re easier to treat. It’s important to stay connected with your doctor and take advantage of any preventive care they recommend — even if you’re feeling well. If you see an in-network provider, preventive care is at no cost to you.*.
Preventive vs. Diagnostic Care
While preventive care evaluates your health now to identify problems early, diagnostic care happens in response to a symptom or problem. Depending on the results of your checkup, your doctor may order more tests that are considered diagnostic care — so there may be additional fees based on the type of coverage your plan offers.
Both types of care can occur during the same visit. For example, when your doctor catches something during your routine checkup (preventive) and orders additional tests (diagnostic).
Watch the video to learn more about these different types of care.
What's covered?
Here are some examples of the preventive checkups and tests covered under your plan:
At No Cost to You*
Preventive Care**
Your routine checkup:
- Annual Wellness Visit
- Cholesterol screening
- Weight and blood pressure screening
- Diabetes screening
- Screening mammogram, MRI, ultrasound
- Screening Pap test
- Tetanus, flu, and booster shots
May Pay More Out-of-Pocket
Diagnostic Care
Lab work and other tests:
- Complete blood panel
- Vitamin D, thyroid, and hormone screening
- Urine test
- Diagnostic imaging tests
- EKG
Register for or log in to My Highmark
to view your preventive schedule and locate in-network diagnostic care.
Your Preventive Services are located under Benefits > Medical.
You can search in-network care by clicking on Get Care and going to Find a Healthcare provider.
Some checkups and tests depend on your sex, age, last visit, or risk factors. You and your doctor can determine what’s best for you. Your coverage is outlined in your plan’s specific preventive schedule.
Cost-Saving Tips
Your doctor is your best resource for what care or tests you may need. But if you’re worried about paying for diagnostic care, there are a few things you can do to keep an eye on costs.
1. When you make your appointment, specify that it's your annual well visit.
2. Make sure you have your preventive schedule handy so you and your doctor know what preventive services are covered.
3. Ask your doctor if the blood work or labs ordered during your visit are preventive care.
4. To pay less out-of-pocket for diagnostic services, use in-network facilities for blood work and imaging. Getting tests outside of a hospital can sometimes help you save too.
*If you are in a non-grandfathered care plan and a preventive treatment has not been added to the preventive schedule, some cost-sharing measures may be applied.
**Please refer to your preventive schedule which includes additional information on what may qualify as preventive care.
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